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<!DOCTYPE html>
<html xmlns:th="http://www.thymeleaf.org">
<head  th:include="magicalcoder/v103/include/head :: commonHead('勘查表编辑')"/>

<body class="childrenBody layui-hide">
<!--请不要删除magicaldrag注释标签，可以配合布局器进行联动布局-->
<!--magicaldrag-->
    <div class="layui-fluid">
        <div class="layui-card">
            <div class="layui-card-header">

            </div>
            <div class="layui-card-body">
                <form class="layui-form">
                    <div class="layui-form-item security_edit_form_param_id">
                        <label class="layui-form-label">查勘编号</label>
                        <div class="layui-input-block">
                            <input type="text" class="layui-input" name="id"  placeholder="查勘编号请保证唯一，如果已存在则会覆盖，如果不填写则新增"/>
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_reportnum">
                        <label class="layui-form-label">报案编号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="reportnum" placeholder="报案编号" lay-verify="magicalCoderVerify|mc_required" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_company">
                        <label class="layui-form-label">单位</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="company" placeholder="单位" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_GuaranreeId">
                        <label class="layui-form-label">保单号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="GuaranreeId" placeholder="保单号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_licensePlateNumber">
                        <label class="layui-form-label">车牌号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="licensePlateNumber" placeholder="车牌号" lay-verify="magicalCoderVerify|mc_required" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_engineNumber">
                        <label class="layui-form-label">发动机号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="engineNumber" placeholder="发动机号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_vin">
                        <label class="layui-form-label">车架号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="vin" placeholder="车架号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_factoryPlateModel">
                        <label class="layui-form-label">厂牌型号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="factoryPlateModel" placeholder="厂牌型号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TroubleDriverName">
                        <label class="layui-form-label">肇事司机姓名</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TroubleDriverName" placeholder="肇事司机姓名" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TroubleDriverPhone">
                        <label class="layui-form-label">肇事司机电话</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TroubleDriverPhone" placeholder="肇事司机电话" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_DrivingType">
                        <label class="layui-form-label">准驾车型</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="DrivingType" placeholder="准驾车型" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_InsuranceCompany">
                        <label class="layui-form-label">承保交强险公司</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="InsuranceCompany" placeholder="承保交强险公司" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_guaranteeId">
                        <label class="layui-form-label">交强险保单号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="guaranteeId" placeholder="交强险保单号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_ThreePlateModel">
                        <label class="layui-form-label">三责厂牌型号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="ThreePlateModel" placeholder="三责厂牌型号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_ThreeCarNum">
                        <label class="layui-form-label">三责车牌号</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="ThreeCarNum" placeholder="三责车牌号" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_ThreeDriverName">
                        <label class="layui-form-label">三责司机姓名</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="ThreeDriverName" placeholder="三责司机姓名" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TroubleTime">
                        <label class="layui-form-label">肇事时间</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TroubleTime" placeholder="肇事时间" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TroubleAddress">
                        <label class="layui-form-label">肇事地点</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TroubleAddress" placeholder="肇事地点" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_surveytime">
                        <label class="layui-form-label">查勘时间</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="surveytime" placeholder="查勘时间" lay-verify="magicalCoderVerify|mc_required" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_surveyaddress">
                        <label class="layui-form-label">查勘地点</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="surveyaddress" placeholder="查勘地点" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_IsFirstSite">
                        <label class="layui-form-label">是否第一现场</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="IsFirstSite" placeholder="是否第一现场" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_IsSecondSite">
                        <label class="layui-form-label">是否第二现场</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="IsSecondSite" placeholder="是否第二现场" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_AccidentLiability">
                        <label class="layui-form-label">事故责任</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="AccidentLiability" placeholder="事故责任" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_InvolvedPlanted">
                        <label class="layui-form-label">涉及险种</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="InvolvedPlanted" placeholder="涉及险种" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_InsuredLiability">
                        <label class="layui-form-label">保险责任</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="InsuredLiability" placeholder="保险责任" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TreatmentMethods">
                        <label class="layui-form-label">处理意见</label>
                        <div class="layui-input-block">
                        <textarea name="TreatmentMethods" placeholder="处理意见" class="layui-textarea" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" ></textarea>
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_LossParts">
                        <label class="layui-form-label">损失部位</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="LossParts" placeholder="损失部位" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_OtherLosses">
                        <label class="layui-form-label">其他损失</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="OtherLosses" placeholder="其他损失" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_Casualties">
                        <label class="layui-form-label">人员伤亡情况</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="Casualties" placeholder="人员伤亡情况" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_Hospital">
                        <label class="layui-form-label">所住医院</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="Hospital" placeholder="所住医院" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_Departments">
                        <label class="layui-form-label">科室</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="Departments" placeholder="科室" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_AdmissionTime">
                        <label class="layui-form-label">入院时间</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="AdmissionTime" placeholder="入院时间" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_CarLossAmount">
                        <label class="layui-form-label">车辆损失金额</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="CarLossAmount" placeholder="车辆损失金额" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_ThreeLossesMoney">
                        <label class="layui-form-label">三责损失金额</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="ThreeLossesMoney" placeholder="三责损失金额" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_OtherLossesMoney">
                        <label class="layui-form-label">其他损失金额</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="OtherLossesMoney" placeholder="其他损失金额" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_total">
                        <label class="layui-form-label">合计</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="total" placeholder="合计" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TroublePhoto">
                        <label class="layui-form-label">事故照片</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TroublePhoto" placeholder="事故照片" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_SurvryBy">
                        <label class="layui-form-label">查勘人员</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="SurvryBy" placeholder="查勘人员" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TypeinTime">
                        <label class="layui-form-label">录入时间</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TypeinTime" placeholder="录入时间" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_TypeinBy">
                        <label class="layui-form-label">录入人员</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="TypeinBy" placeholder="录入人员" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item security_edit_form_param_state">
                        <label class="layui-form-label">状态</label>
                        <div class="layui-input-block">
                        <input type="text" class="layui-input" name="state" placeholder="状态" lay-verify="magicalCoderVerify" magicalcoder-verify="|minLength=0" value="" />
                        </div>
                    </div>
                    <div class="layui-form-item ">
                        <div class="layui-input-block">
                            <a class="layui-btn security_edit_form_operate_save" lay-submit="" lay-filter="save">立即提交</a>
                            <button type="reset" class="layui-hide layui-btn layui-btn-primary" >重置</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>
    </div>
<!--/magicaldrag-->
    <div th:replace="magicalcoder/v103/include/main-js :: commonMain" />
    <script type="text/javascript"  th:src="@{/assets/admin/survey/edit.js}"></script>
</body>
</html>
